1. Case 1 37-year old male comes to the hospital complaining of palpitation for 8 months, no other symptoms: no sweating, wt loss,ischaemic chest pain, anxiety or pleuretic chest pain. On examination, BP is 100/70, normal heart sounds, no murmurs/gallops. On examination, BP is 100/70, normal heart sounds, no murmurs/gallops.

3. 1. What is the most commonly encountered “premature contraction?” a. a ventricular premature beat b. an atrial premature beat b. an atrial premature beat c. atrial flutter d. atrial fibrillation d. atrial fibrillation e. I do not know

4. 2. Most atrial premature beats discovered on clinical examination are: a. associated with COPD b. completely benign c. associated with valvular heart disease d. associated with an increase in cardiovascular mortality e. I do not know

5. Case 2 A 40 year old female comes to the ER C/O of palpitations. Denies chest pain or SOB. No known history of CAD. There is history of weight loss and anxiety. A 40 year old female comes to the ER C/O of palpitations. Denies chest pain or SOB. No known history of CAD. There is history of weight loss and anxiety. On physical examination, BP is 130/60 and heart rate is 160 irregular. On physical examination, BP is 130/60 and heart rate is 160 irregular.

6. Strip ECG: show this rhythm What is the diagnosis, investigation and treatment?

7. A 50 year old male is brought to the emergency department c/o of severe substernal chest pain, nausea, diaphoresis. BP is 90mm Hg systolic, HR 120 bpm. Pulse disappears on arrival. Venous access is established and he has O2 via mask. ECG was done Case 3

8. What is your favorable diagnosis?

10. The appropriate management at this time includes: The appropriate management at this time includes: 1. Lidocaine 1 mg/kg IV bolus 2. Procainamide, 20mg/min IV infusion 3. Defibrillation 4. Transvenous pacemaker 5. Oral beta- blockers

11. His rhythm stabilizes and you note evidence of acute MI on ECG. Which of the following should be taken into account when considering thrombolytic therapy? His rhythm stabilizes and you note evidence of acute MI on ECG. Which of the following should be taken into account when considering thrombolytic therapy? 1. Degree of coronary occlusion 2. Whether the patient has a hx of stroke 3. Time interval from onset of sxs